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Clinical Issues™

Clinical Issues in Bipolar Depression

Consensus and Controversies Across the Spectrum of Patient Presentations

Meeting Slides

Guidelines

Diagnostic and Statistical Manual of Mental Disorders (Fifth edition). 2013.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (Fifth edition). Arlington, VA: American Psychiatric Publishing

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults (Third edition). 2016.

Arlington, VA: American Psychiatric Publishing.

2015 Florida Best Practice Psychotherapeutic Medication Guidelines for Adults.

The University of South Florida, Florida Medicaid Drug Therapy Management Program for Behavioral Health.

 

Patient Resources

Depression and Bipolar Support Alliance

The Depression and Bipolar Support Alliance (DBSA) offers resources for patients, materials for clinicians, information on mental health research, as well as listings of patient support groups across the United States.

Clinical Assessment Tools

Clinically Useful Depression Outcome Scale with questions for the DSM-5 mixed features specifier (CUDOS-M)

This self-administered assessment scale detects the presence of mixed features in patients with major depressive disorder. With a rating scale of 0-4, where 0 is not at all true and 4 is almost always true, patients endorse the frequency of each symptom experienced during the prior week (Zimmerman M, et al. J Affect Disord. 2014;168:357-362).

Montgomery-Asberg Depression Rating Scale (MADRS)

This clinician-scored questionnaire assesses the severity of patient depression over the prior week on a scale of 0-6, where 0 denotes no symptoms and 6 indicates the most severe symptoms (Montgomery SA, Asberg M. Brit J Psychiatry. 1979;134:382-389).

The Bipolarity Index

This clinician-rated scale aims to provide diagnostic confidence when evaluating a patient with suspected bipolar disorder. Five sections evaluating the 5 illness dimensions are each scored from 0-20, with a final score ≥50 indicative of bipolar disorder (Sachs GS. Acta Psychiatr Scand. 2004;422(suppl):S7-S17; Aiken CB, et al. J Affect Disord. 2015;177:59-64).

The Mood Disorder Questionnaire (MDQ)

This self-administered assessment scale is intended to help clinicians screen patients for bipolar disorder. The 5-question evaluation can be completed in less than 5 minutes and provides important insight into diagnosis and treatment. A positive screen is noted if a patient answers YES to ≥7 out of 13 items in question 1, YES to question 2, and MODERATE or SERIOUS to question 3 (Hirschfeld RMA. Prim Care Companion J Clin Psychiatry. 2002;4(1):9-11).

Young Mania Rating Scale (YMRS)

This clinician-guided assessment is intended to identify the severity of patient abnormalities. The 11-statement assessment is used to describe the patient’s symptoms over the prior week through scoring on a 0-4 scale, where 0 is absence of symptoms (feeling normal) and 4 indicates the most severe symptoms (Young RC, et al. Br J Psychiatry. 1978;133(5):429-435).

Suggested Readings

Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: a scientific statement from the American Heart Association.

Goldstein BI, et al. Circulation. 2015;132(10):965-986. 2015;8(4):206-220

Mixed specifier for bipolar mania and depression: highlights of DSM-5 changes and implications for diagnosis and treatment in primary care.

Hu J, et al. Prim Care Companion CNS Disord. 2014;16(2).

The prevalence and illness characteristics of DSM-5-defined “mixed feature specifier” in adults with major depressive disorder and bipolar disorder: Results from the International Mood Disorders Collaborative Project.

McIntyre RS, et al. J Affect Disord. 2015;172:259-264.

Lurasidone in the treatment of bipolar depression with mixed (subsyndromal hypomanic) features: post hoc analysis of a randomized placebo-controlled trial.

McIntyre RS, et al. J Clin Psychiatry. 2015;76(4):398-405.

Mixed depression in bipolar disorder: prevalence rate and clinical correlates during naturalistic follow-up in the Stanley Bipolar Network.

Miller S, et al. Am J Psychiatry. 2016; Apr 15. [Epub ahead of print].

A 6 week randomized double-blind placebo-controlled trial of ziprasidone for the acute depressive mixed state.

Patkar A, et al. PLoS One. 2012;7(4):e34757.

Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).

Perlis RH, et al. Am J Psychiatry. 2006;163(2):217-224.0

Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study.

Perugi G, et al. J Clin Psychiatry. 2015;76(3):e351-e358.

Factors related to suicidal behavior in patients with bipolar disorder: the effect of mixed features on suicidality.

Seo HJ, et al. Gen Hosp Psychiatry. 2016;39:91-96.

Efficacy of olanzapine monotherapy in the treatment of bipolar depression with mixed features.

Tohen M, et al. J Affect Disord. 2014;164:57-62.

Heterogeneity of DSM-IV major depressive disorder as a consequence of subthreshold bipolarity.

Zimmermann P, et al. Arch Gen Psychiatry. 2009;66(12):1341-1352.

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